WJPCHS Presidential Address: Threats to the Continuing Globalization of Early Primary Repair

Abstract

The outgoing presidential address presented by the author at the July 2018 meeting of the World Society for Pediatric and Congenital Heart Surgery focuses on forces threatening the movement toward single-stage repair of congenital heart anomalies in the young. Issues that are of particular importance in the United States are challenges in training the next generation of surgeons, an increasing percentage of premature neonates, and the use of data analytics by hospital administration which incentivizes inflation of procedural numbers. However, the most important factor is the ranking of hospitals by the lay press with heavy emphasis on early procedural mortality rather than patient survival. In contrast to current databases used for such rankings, the new World Society database is planning to collect patient admissions rather than procedural number as the key denominator to allow accurate calculation of patient survival. The current heavy weighting of procedural success (ie, early hospital mortality) in establishing rankings of hospitals is encouraging centers to undertake palliative procedures in high-risk patients or avoiding a surgical procedure altogether.